Abstract
Introduction
Adult-onset autosomal dominant leukodystrophy (ADLD) is a rare genetic leukoencephalopathy caused by duplication of the lamin B1 gene (LMNB1) or LMNB1 upstream deletions. Neuronal intranuclear inclusion disease (NIID) is another leukoencephalopathy due to GGC repeat expansion in the 5′-untranslated region of the NOTCH2NLC gene. Here, we report two Chinese ADLD families with neuroimaging and clinical features mimicking NIID.
Methods
We conducted detailed medical history inquiry, neurological examinations, and magnetic resonance imaging in the two families. Candidate gene sequencing and whole exome sequencing (WES) with copy number variation analysis were used to screen the genetic variations. The special points on the clinical and neuroimaging findings in the current families and differential diagnosis of ADLD with NIID are discussed.
Results
The two families presented with slowly progressive, multiple central nervous system symptoms, including spastic paraplegia, autonomic dysfunction, ataxia, deep sensory loss, and tremor. Clinical phenotypes were consistent within the family. Transient hypoglycemia and transient dilated pupils indicating autonomic dysfunctions were recorded for the first time in ADLD. Brain MRI showed band-like hyperintensities at the cortico-medullary junction on DWI, typical for NIID. Skin biopsy and genetic sequencing of the NOTCH2NCL gene did not support the diagnosis of NIID. Further whole exome sequencing (WES) identified the duplication mutation spanning the entire LMNB1 gene.
Conclusions
The novel feature of transient hypoglycemia and dilated pupils broadens the spectrum of autonomic dysfunction in ADLD. Clinical manifestations and neuroimaging of ADLD can mimic NIID. Although ADLD is even rarer than NIID, the differential diagnosis of these two diseases should not be confused.
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Funding
This study was supported by the Henan Natural Science Fund (212300410241) and Henan medical science and technology research program (LHGJ20210067).
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This study was approved by the local ethical committee. Written informed consent for clinical data collection and genetic testing were obtained from the probands and their relatives.
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Supplementary Information
ESM 1
Fig S1-1: T1WI images for proband 1 (PNG 2272 kb)
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Fig S1-2: T2WI images for proband 1 (PNG 3313 kb)
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Fig S1-3: FLAIR images for proband 1 (PNG 2724 kb)
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Fig S1-4: DWI images for proband 1 (PNG 3014 kb)
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Fig S2-2: T1WI images for proband 2 (PNG 3961 kb)
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Fig S2-2: T2WI images for proband 2 (PNG 3923 kb)
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Fig S2-3: FLAIR images for proband 2 (PNG 3565 kb)
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Fig S2-4: DWI images for proband 2 (PNG 2145 kb)
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Chen, S., Zou, JL., He, S. et al. Adult-onset autosomal dominant leukodystrophy and neuronal intranuclear inclusion disease: lessons from two new Chinese families. Neurol Sci 43, 1–9 (2022). https://doi.org/10.1007/s10072-022-06057-0
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DOI: https://doi.org/10.1007/s10072-022-06057-0